Question

MI is a male patient in your pharmacy who has a creatinine clearance of 25 ml/min, has hypertension, hyperlipidemia, past anterior MI, and has been diagnosed with chronic hepatitis B with cirrhosis Child-Pugh B. His physician wants to start treatment with Tenofovir Alafenamide (Vemlidy®).

HBsAg + , HBeAg + , HBV DNA 18,000 IU/ml, ALT = 140 U/L, AST = 125 U/L

Your care plan recommendations include:

1. Collect

2. Asses

3. Plan

4. Implement

5. Follow-up

Answer 1

(1) COLLECT ;-

Collect the data from the patient by   observing , assessing , interview , performing the test , and procedures .

(2) ASSESS;-

Although health history and physical examination are necessary .

A complete history is obtained to assess for symptoms that indicate target organ damage ( whether other body symptoms have been affected by the elevated blood pressure ) . such symptoms may include - anginal pain , shortness of breath , alteration in speech , vision , or balance , nosebleeds , headache , dizziness or nocturia . The retina are examined and laboratory studies are performed to assess posible target organ damage .

Routine laborartory test include ;- Urinalysis , blood chemistry ( i.e - analysis of sodium , potassium , creatinine , fasting glucose and total - density lipoprotein(HDL) , cholestreol level .)

And a 12 - lead electrocardiogram

If renal damage may be suggested by the elevation in BUN and creatinine level or by microalbuminuria or macroalbuminuria , Additionally studies , such as creatinine clearance , renin level , urine test and 24- hour urine protein may be performed .

During the physical examination , the nurse must also pay specific attention to the rate , rhythm and character of the apical and peripheral pulses to detect effects of hypertension on the heart and blood vessels . A thorough assessment can yeild valuable information about the extent to which the hypertansin has affected the body and about any other personal , social , or finacial related to the condition .

In determing the phase of hepatitis B virus (HBV) infection is essential to the clinical assessment of the patient with HBV , HBV DNA , HBeAg status and liver function testing are all vitl components of this assessment .. Fibrosis assessment to determine the stage of liver disease is also important ( non- invasive tests , imaging with or without biopsy ) The non- invasive methods of assessing hepatic fibrosis such as transient elastography are becoming available .

Alanine aminotransferase (ALT) and aspartate aminotransferase (APT ) gives the huge evidence in studying the HBV. plus complete HBV serology - HBsAg and Anti -HBc and HbeAg and Anti - Hbe and measurement of HBV DNA level should be performed initially to evaluate HBV replication status .

HBsAg is the first serological marker to appear and its presence for more than 6 months indicates CHB infecton .HBsAg appears in serum 4-10 weeks after exposure , proceding the onset of symptoms of chronic hepatitis and alanine amintransferase (ALT ) elevation.

    
(3) PLAN;-

The major goals for the patient include understanding of the disease proecss and its treatment , participation in a self - care program and absence of complications .

maintain and expand HBV immunization programs in order to increase coverage the patient as well as to all the community area and for members of key population and vulnerable groups .

makes the plan for action that are based on the following strategies ;-

• promoting an integrated comprehensive response
• Fostering equitable access to preventive care
• Fostering equitable access to clinical care  
• strengthening strategic information
• strengthening laboratory capacity and a safe blood supply

(4) IMPLEMENT;-

THe objective of nursing care for hypertension patient focuses on the lowering and controlling the blood pressure without adverse effects and without undue cost . To acheive these goals , the nurse must support and teach the patient to adhere to the treatment regimen by implementing necessary lifestyle changes , taking medication as prescribed .

promotion of prevention , treatment , rehabilitation and relaed support services that take into the account of priorties of action

Establish of specific strategies for prevention of transmission of hepatitis B , these stratigies take into account action includes outreach and educational interventions as wellas promotion of treatment and should also encourage health - seeking behaviours ( e,g - screening for asymptomatic infection) and utilization of care and treatment services .

(5) FOLLOW UP ;-

Scheduling a regular follow up appointments with the health care provider to monitor the progress or identify and treat any complication of disease or therapy . and restoring the strength and a capacity of the patient to follow the the rehabilations process .